Healthcare Science in Scotland: Defining Our Strategic Approach: Equality Impact Assessment Record

Stage 2: Data and evidence gathering, involvement and consultation

Include here the results of your evidence gathering (including framing exercise), including qualitative and quantitative data and the source of that information, whether national statistics, surveys or consultations with relevant equality groups.

Characteristic

Age

Evidence gathered and Strength/quality of evidence

Age is relevant to this EQIA because changes and improvements to healthcare science will affect both the workforce and the wider population. Whilst this ‘Strategic Approach’ paper does not set out specific actions to be taken, it highlights areas in which we know age will have an impact as part of future papers in this series of documents. As such, high level evidence has been gathered at this stage which should be built upon as part of the next phase of work within this series.

Workforce

NHS Scotland Workforce shows that as of 31 March 2023, there were 156,178.7 Whole Time Equivalent (WTE) staff employed by NHS Scotland. For Healthcare Science the number of WTE staff within the healthcare science family has generally risen over time, with a slight reduction from 31 March 2022.

The median age of the people employed in NHS Scotland on 31 March 2023 was 44. The age distribution of people employed in NHS Scotland varies between job families. Within healthcare science those age 40-44 represent the highest percentage headcount, followed by those age 30-39 (at 31 March 2023). It should be noted that there is a significant number of staff age 50-59 who make up this job family headcount (NHS Scotland Workforce).

Population

As of 22 August 2022, Scotland’s population was at 5.44 million and most recent census figures show Scotland as an ageing population with more people being over 65 than under 15 (Scotland's Census 2022).

By 2040, residents in Scotland aged sixty-five years or older will number an estimated 1.4 million people, which is around 25% of the population (Projected Population of Scotland).

The Health and Social Care Strategy for Older People - Consultation Analysis describes an increasing use of medications, attendance at healthcare appointments and admissions to hospital – with 70% of emergency admissions being those who are aged 65 and over.

Anecdotally, the proportion of adults who self-assessed their general health as ‘very good’ or ‘good’ decreased with age in 2021 as part of the Scottish Health Survey (The Scottish Health Survey 2021).

Data gaps identified and action taken

It should be noted here that there is evidence to suggest that specific data for the healthcare science workforce is inconsistent, primarily due to a lack of standardisation about roles and where these sit within job families. Work is ongoing to address this but in respect of measuring evidence as part of this EQIA this should be considered.

As part of future papers in the ‘Healthcare Science in Scotland’ series we will consider how to use data and insights in relation to the age of the workforce and the wider population to help shape the specific actions to be taken within healthcare science and ensure delivery of quality services which meet the needs of patients.

There is clear evidence of an aging population, this is coupled with a workforce which is also aging. As such there is a need for future papers to give specific consideration to how we:

• Continue to attract people of all ages to the profession to ensure a continued pipeline of appropriately trained staff
• Ensure changes to services to not negatively impact those who are nearing the end of their careers – for example if mandatory training or registration was introduced.
• Ensure the healthcare science workforce is appropriately skilled and equipped to deal with changing health needs of the population.
• Consider system design and re-design to take into account the aging population and the NHS Scotland ability to respond to that.

Characteristic

Disability

Evidence gathered and Strength/quality of evidence

Workforce

According to NHS staff respondents to iMatter (iMatter 2022 National Report (www.gov.scot)), when it asked, “Do you consider yourself to be disabled within the definition of the Equality Act 2010?” 88% responded with ‘no’, 6% with ‘yes’ and 6% provided no comment. It should be noted however, that the response rate was 55% of the total workforce and as such it is possible to suggest the figures are not an accurate representation of the workforce in relation to disability.

Population

Healthcare science involves direct interaction between the workforce and patients, using equipment to investigate biological systems within the body and can include management of diseases and conditions (Manchester Academy HCS Education. The scientific workforce can therefore be responsible for the diagnosis of conditions which result in a patient being classed as having a disability – for example hearing loss, cancer or Bloodborne Vivus Infection such as HIV which could have a ‘substantial’ and ‘long-term’ negative effect on an individual’s ability to undertake daily activities (Definition of disability under the Equality Act 2010).

Data gaps identified and action taken

Full consideration of how future actions to be undertaken in relation to changes to services will need to be assessed through an EQIA for that specific piece of work. It is not possible to list specific impacts here as the document this EQIA covers does not outline specific actions which will or should be undertaken.

Future work within the development of healthcare science will directly impact people with a disability due to the nature of the profession and as such it is imperative that future work and potential changes within the system are underpinned by a robust EQIA.

Characteristic

Sex

Evidence gathered and Strength/quality of evidence

Workforce

Females account for 78.8% of people employed in NHS Scotland, although this varies between job families. As at 31 March 2023 the comparative headcount of females working in the healthcare science job family was around two thirds of the total headcount (NHS Scotland Workforce).

Population

Some evidence suggests that men are more likely to experience poorer health outcomes for a range of conditions compared to women and there are noted risk factors that are more common among men than women in the UK. (UK Parliament Research Briefing). However, there is also evidence that there is a gender health gap in the UK as a whole – with women receiving poorer care then men (Women’s health outcomes - House of Lords Library).

Data gaps identified and action taken

It should be noted here that there is evidence to suggest that specific data for the healthcare science workforce is inconsistent, primarily due to a lack of standardisation about roles and where these sit within job families. Work is ongoing to address this but in respect of measuring evidence as part of this EQIA this should be considered.

Further data is required on the potential impact of any future activity in relation to improvements to healthcare science in Scotland and how this will affect patient outcomes in both men and women. It is not possible to give full consideration to the impacts of policy change as part of this EQIA as the paper to which it relates does not set out specific changes or actions to be undertaken. A more in depth consideration of impacts on sex as a characteristic should be made in future papers as part of this series.

Characteristic

Pregnancy and Maternity

Evidence gathered and Strength/quality of evidence

Workforce

According to the NHS staff respondents to iMatter 2022, when it asked: ‘Have you been on maternity/parental or shared parental leave in the last 12 months?’, 3% responded as ‘yes’, 90% responded as ‘no’ and 7% provided no answer.

We know that some healthcare science services require precautions to be put into place for staff who are pregnant – for example certain tests in pathology or exposure to radioactive isotopes in the first trimester of pregnancy. This should be managed at a local level within the Health Board, in line with best available evidence.

Population

National Services Scotland co-ordinate the provision of pregnancy screening (Pregnancy screening in Scotland (nhsinform.scot) ) and the newborn blood spot screening (Newborn blood spot screening | National Services Scotland (nhs.scot)) which would be processed by laboratory staff who are healthcare scientists. Uptake of newborn screening was 99.2% in 2022-23 (Public Health Screening Programme Annual Report) indicating the impact of healthcare sciences on pregnancy and maternity.

Audiology staff are also classed as healthcare scientists and will therefore perform procedures in relation to diagnosis of newborn children Newborn hearing test in Scotland (nhsinform.scot). There is currently work underway in Scotland to consider improvements to audiology care following an independent review of audiology services independent-review-audiology-services-scotland.. This work originated following an audit within NHS Lothian identifying 15.7% of cases of children which had been included in the audit as having “significant failures” in their care BAA-Summary-Report_NHS-Lothian-Paediatric-Audiology.

Data gaps identified and action taken

There is likely to be a limited impact on pregnancy and maternity in respect of the workforce, when considering changes and improvements to healthcare science in Scotland. However, this should still be included as part of further EQIAs to ensure impacts are fully considered.

There are no specific actions contained within this paper which demonstrate an impact on the wider population when thinking about pregnancy and maternity. However, it is important to consider the areas in which there will be crossover with healthcare science specialisms and diagnosis or treatment in the widest sense. As such, high level evidence has been gathered here but this should be explored in future EQIAs when specific actions or recommendations are being made.

This is particularly true in respect of audiology where improvement work is already underway but which will influence work happening under this series in the future.

Characteristic

Gender Reassignment

Evidence gathered and Strength/quality of evidence

Workforce

According to NHS staff respondents to iMatter 2022, when asked, “Do you consider yourself to be trans, or have a trans history?”, 90% responded as ‘no’, less than 1% responded as ‘yes’ and 7% provided no answer. The relatively low response rate should be noted here however, so these figures do not represent the workforce as a whole.

Population

Some laboratory measurements use sex-specific reference ranges which can lead to difficulties or errors in treatment for patients who have undergone or who are going through gender reassignment (Gender-specific-reference-ranges-for-blood-tests.pdf (nhslothian.scot)). There appears to be limited data on what the level of error in relation to misdiagnosis is but it is worth noting this given the specific responsibilities of healthcare scientists in this space.

Data gaps identified and action taken

There are no specific actions contained within this paper which will directly impact those who have undergone or are undergoing gender reassignment. However, it is important to note that future changes to services may directly impact this group and as such this should be explored further in future EQIAs, where specific actions or recommendations are being set out or developed as part of a policy paper.

Characteristic

Sexual Orientation

Evidence gathered and Strength/quality of evidence

Workforce

According to NHS staff respondents to iMatter 2022, when it asked, “Which of the following best describes your sexual orientation?”, 88% responded as ‘straight/heterosexual’, 2% responded as ‘gay or lesbian’, 1% responded as ‘bisexual’, 1% ‘preferred to self-describe’ and 7% provided no answer. The relatively low response rate should be noted here however, so these figures do not represent the workforce as a whole.

Population

An estimated 3.3% of the UK population aged 16 years and over identified as lesbian, gay or bisexual (LGB) in 2022, a continued increase from 2.1% in 2017 (Sexual orientation, UK - Office for National Statistics.

There is evidence of health inequities between LGBT+ and cis-heterosexual groups but the evidence base can be described as limited, particularly in relation to some specific areas of healthcare The Politics of LGBT+ Health Inequality: Conclusions from a UK Scoping Review - PMC (nih.gov)

Additionally, there is evidence which suggests that health services need to be more inclusive for LGBT+ people in Scotland (Health needs assessment of lesbian, gay, bisexual, transgender and non-binary people (scot.nhs.uk)).

Data gaps identified and action taken

There are no specific actions contained within this paper which will directly impact individuals as a result of their sexual orientation. However, it is important to note that future changes to services may directly impact this group and as such this should be explored further in future EQIAs, where specific actions or recommendations are being set out or developed as part of a policy paper.

Characteristic

Race

Evidence gathered and Strength/quality of evidence

Workforce

In response to the iMatter 2022 survey, NHS staff identified themselves as; White 90%, Mixed or multiple ethnic groups 1%, Asian, Scottish Asian or British Asian 2%, African, Scottish African or British African %, Caribbean or Black less than 1%, another ethnic group, less than 1% and no answer given was 7%, when asked ‘what is your ethnic group?’ The relatively low response rate should be noted here however, so these figures do not represent the workforce as a whole.

Population

Certain minority ethnic groups (primarily South Asian) have higher rates of some specific conditions compared with the ‘White Scottish’ population (The Race Equality Framework and the Immediate Priorities Plan. Healthcare scientists, for example in cardiac physiology, are directly responsible for supporting cardiac testing and treatment alongside other members of a multidisciplinary team (What does a cardiac physiologist do?).

Those within the Gypsy/Traveller community also face barriers in accessing health services and are less likely to take up preventative health services and more likely to miss appointments due to a lack of postal addresses (Health Inequalities in the Gypsy, Roma and Traveller Community). This community has some of the worst physical and mental health outcomes (Improving access for Gypsy/Travellers to the NHS).

Those within the Gypsy/Traveller community also face barriers in accessing health services and are less likely to take up preventative health services and more likely to miss appointments due to a lack of postal addresses (Health Inequalities in the Gypsy, Roma and Traveller Community). This community has some of the worst physical and mental health outcomes (Improving access for Gypsy/Travellers to the NHS).

Data gaps identified and action taken

There are no specific actions contained within this paper which will directly impact individuals as a result of their race. However, it is important to note that future changes to services will likely have a direct impact on improving outcomes for all patients. Future EQIAs, where specific actions or recommendations are being set out or developed as part of a policy paper should explore the impacts on race in further detail.

Characteristic

Religion or Belief

Evidence gathered and Strength/quality of evidence

Workforce

According to NHS staff respondents to iMatter 2022, when asked ‘What religion, religious denomination or body do you belong to?’, None was 52% Church of Scotland 20%, Roman Catholic 14%, Other Christian, 4% Muslim 1%, Hindu, Buddhist, Sikh, Jewish and Pagan was less than 1%, another religion or body was 1% and no answer given was 7%.

Population

There is limited evidence about the impact of religion and belief on healthcare science in Scotland. However, consideration needs to be given in the wider sense to how healthcare science interacts with patients with specific religious beliefs. For example Jehovah’s Witnesses typically refuse transfusion of whole blood and primary blood components (Jehovah's Witness management, paediatric patients) so transfusion services would need to be aware of this and ensure appropriate protocols are in place.

Data gaps identified and action taken

There are no specific actions contained within this paper which will directly impact individuals as a result of their religion or belief but this should be considered again as part of future work when specific actions or recommendations are suggested.